Insurer-medical provider split leaves DC residents indecisive

Earlier this month, some D.C. residents were asked to choose whether to stay with their medical practice or their health insurer. Patients received an email from One Medical, a 10-year-old concierge medical practice with facilities spread in seven major cities across America, including six of them in Washington, D.C.

One Medical and CareFirst, two big partners, have decided to cease their cooperation, after failed negotiations on the increased rate and additional charges.

The email stated that by mid-December, CareFirst BlueCross BlueShield will no longer be one of the health insurance companies that One Medical works with, meaning that patients enrolled in CareFirst’s health plans will have to make a definite choice of whether to keep going to One Medical with another insurance company or to stay with their health plans and find another medical practice.

“We shouldn’t have to choose between efficient medical care and insurance,” Jenny Martin, an Arlington resident, wrote on Facebook. She called One Medical a “breath of fresh air” after having some bad experiences with other medical practices in the area.

In an interview, Martin said that she hasn’t talked to the practice yet, nor had she decided to stay or leave One Medical. But she did understand that her copayments are likely to go from $10 to $40 every time she visits a physician.

One Medical runs a membership mode service, where members pay an annual fee of $199 to have access to same-day appointment and immediate medical help via smartphone apps. Registered patients are also exempt from paying a fee for every visit they make, which is $175 for the initial one and $125 for the follow-ups.

If a patient has a plan provided by CareFirst, however, he or she can waive such fee and enjoy the same service.

“These costs have become harder and harder to bear.”

CareFirst stated that the end of its partnership with One Medical was due to the increased rate and additional charges that the practice has been asking from CareFirst, according to a press release.

The charges could “come directly out of the pockets of our members and the employer groups to which they belong and these costs have become harder and harder to bear,” the release said.

The negotiation with One Medical is still on-going. But even without what One Medical has asked, CareFirst will increase its rate next year anyway.

According to D.C.’s Department of Insurance, Securities, and Banking, CareFirst has proposed an increase of 39.6 percent for its HMO rate and 19.7 percent for Preferred Provider Organization (PPO), a health plan that partners with medical providers. The approved rate change from last year was 22.8 percent and 1.8 percent respectively.

Robin Summers, a writer who works in public policy in D.C., started a petition on change.org, calling for One Medical and Carefirst to stay together.

“Regardless of what led to the breakdown in the relationship between CareFirst and One Medical or who is to blame,” the petition letter states, “the end of One Medical’s inclusion as an in-network provider through CareFirst will be a significant problem for many in the DC area.”